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Multicenter Study
. 2022 Jun 15:13:898384.
doi: 10.3389/fendo.2022.898384. eCollection 2022.

Admission Blood Glucose and 2-Year Mortality After Acute Myocardial Infarction in Patients With Different Glucose Metabolism Status: A Prospective, Nationwide, and Multicenter Registry

Kongyong Cui  1 , Rui Fu  1 , Jingang Yang  2 , Haiyan Xu  2 , Dong Yin  1 , Weihua Song  1 , Hongjian Wang  1 , Chenggang Zhu  1 , Lei Feng  1 , Zhifang Wang  3 , Qingsheng Wang  4 , Ye Lu  5 , Kefei Dou  1 , Yuejin Yang  2
Affiliations
Multicenter Study

Admission Blood Glucose and 2-Year Mortality After Acute Myocardial Infarction in Patients With Different Glucose Metabolism Status: A Prospective, Nationwide, and Multicenter Registry

Kongyong Cui et al. Front Endocrinol (Lausanne). .

Abstract

Background: The prognostic effect of admission blood glucose (ABG) for patients with acute myocardial infarction (AMI) has not been well validated, especially in patients with diabetes. We performed this study to assess the predictive value of ABG for all-cause mortality in AMI patients with different glucose metabolism status.

Methods: We evaluated a total of 6,892 AMI patients from the prospective, nationwide, multicenter CAMI registry, of which 2,820 had diabetes, 2,011 had pre-diabetes, and 2,061 had normal glucose regulation (NGR). Patients were divided into high ABG and low ABG groups according to the optimal cutoff values of ABG to predict 2-year mortality for patients with diabetes, pre-diabetes and NGR, respectively. The primary endpoint was all-cause mortality.

Results: The optimal cutoff values of ABG for predicting 2-year mortality was 9.0mmol/l, 7.2mmol/l and 6.2mmol/l for patients with diabetes, pre-diabetes and NGR, respectively. Overall, the risk of all-cause mortality in high ABG group was significantly increased compared with that in low ABG group among patients with diabetes (15.2% vs. 8.9%; hazard ratio [HR] 1.787, 95% confidence interval [CI] 1.413-2.260; P<0.0001), pre-diabetes (12.1% vs. 6.1%; HR 2.069, 95%CI 1.518-2.821; P<0.0001) and NGR (11.8% vs. 6.1%; HR 2.009, 95%CI 1.473-2.740; P<0.0001). After the potential confounders were adjusted, high ABG was significantly associated with higher risk of 2-year mortality in patients with diabetes (adjusted HR 1.710, 95%CI 1.327-2.203; P<0.0001), pre-diabetes (adjusted HR 1.731, 95%CI 1.249-2.399; P=0.001) and NGR (adjusted HR 1.529, 95%CI 1.110-2.106; P=0.009). Moreover, adding ABG to the original model led to a slight albeit significant improvement in C-statistic and net reclassification in patients with diabetes and NGR (all P<0.05).

Conclusions: This study is the first to demonstrate a strong positive association between ABG and 2-year mortality in AMI patients with diabetes, pre-diabetes and NGR. ABG should be considered as a useful marker for risk stratification in patients with diabetes and NGR. Further randomized trials are warranted to investigate the effects of blood glucose control on the reduction of long-term mortality according to the corresponding ABG thresholds for different glucose metabolism status.

Clinical trial registration: ClinicalTrials.gov, identifier NCT01874691.

Keywords: 2-year mortality; acute myocardial infarction; admission blood glucose; glucose metabolism status; stress hyperglycemia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study. ABG, admission blood glucose; AMI, acute myocardial infarction; CAMI, China Acute Myocardial Infarction.
Figure 2
Figure 2
Kaplan–Meier curves for all-cause mortality according to admission blood glucose levels in patients with different glucose metabolism status. (A) diabetes; (B) pre-diabetes; (C) normal glucose regulation. ABG, admission blood glucose.
Figure 3
Figure 3
Unadjusted and adjusted association between admission blood glucose and clinical outcomes in patients with different glucose metabolism status. (A) diabetes; (B) pre-diabetes; (C) normal glucose regulation. CI, confidence interval; MACCE, major adverse cardiovascular and cerebrovascular event.
Figure 4
Figure 4
Subgroup analysis for all-cause mortality in patients with different glucose metabolism status. (A) diabetes; (B) pre-diabetes; (C) normal glucose regulation. ABG, admission blood glucose; CI, confidence interval; NSTEMI, non-ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.
See this image and copyright information in PMC

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